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Author
Topic: why is there no cure for lypo? (Read 12950 times)

i am a long term survivor. been dealing with fat on the back of my neck for a long time. also on my belly, along with extra fat just above the penis. why no cure for this? anyone know of any drugs that are suppose to suppress this?

What you're really dealing with, as far as I know, is mitochondrial toxicity damage when discussing lipo, and as such once you have it this can't actually be reversed easily or quickly. The best way presently is simply by cosmetic means, which of course is not optimal.

Peripheral neuropathy is the same -- mitochondrial. Similarly it isn't easily treated.

One basic reason that there is no cure or treatment is that very little research is being done into this area. It's simply not a priority for medical researchers, who are more focused on finding treatments for HIV itself. Another reason is that lots of doctors incorrectly view it as nothing more than a "cosmetic" problem. The drug companies are interested in it only insofar as it concerns the drugs they produce. That is, they want to figure out why a given drug might cause it, because if the drug is known to cause lipo, that will suppress sales. As far as I can tell, no one is researching the role that HIV itself plays in the development of lipo.

Research is being done in this area,but if you look at the literature no one really knows what is causing this. We do know some meds are responsible,but there is also much speculation that HIV itself is also responsible. I would be surprised if there isn't a med in the next 5 years specifically targeted at belly fat, due to its significance with metabolic syndrome. Unfortunately, fat behind the neck, while a significant problem for some of us doesn't get the attention from big pharma because it's not associated with other systemic issues.ie cardiovascular dz, diabetes, etc.

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"Faith is blind trust in the absence of evidence, even in the teeth of evidence" -Sir Richard Dawkins (Darwin's Rottweiler)

There need not be any "speculation that HIV itself is also responsible." As I've said many times in this forum, I have lipo and I've never taken any antiretroviral medications. HIV definitely causes lipo, at least in some people. Drugs are clearly a factor in many, many cases, but there shouldn't be any doubt by now that HIV itself plays a role. The fact that I still see see doctors on sites like thebody.com talking about how lipodystrophy is caused by drugs shows how little attention is being paid to HIV's role in causing this condition.

A drug to treat visceral fat accumulation is already in development, and it's been discussed elsewhere in this forum. It appears to be modestly effective, leading to something like a 15-20% reduction in visceral fat.

Bobino, do you have any data on how many patients are experiencing lipo in the absence of any history of HAART? You're the only one I've heard make this claim, and mind you -- I do believe you, and do believe that HIV infection is at play as well. But I think it bears repeating that the large percentage of people that experience this monstrosity have been on meds used during the 90's.

No, I have no data. I don't know that any such data exist. One of the docs on thebody.com told me that he'd seen one other patient like me. Like me, she had lipo despite taking no meds and having an undetectable viral load. I understand that the drugs play a huge role in most cases. I just wish people would realize that drugs aren't all that's at work.

Well, no offense, but if there's only two of you there's no wonder nobody's saying anything. I mean, I'm sure that it's quite frustrating... but how do they not know if it can be attributed to something not even connected to HIV in these two odd situations?

I think you misunderstood me. All I said was that I personally am aware of only two such cases. I have heard anecdotally of others from doctors with whom I have consulted. So it looks like there are more of us out there, but obviously, we are a distinct minority. I should mention that when I consulted with Carl Grunfeld, who is a leading researcher in this field, he told me that his research has shown that HIV causes fat loss in virtually anyone infected, whether or not they are on antiretroviral drugs. Apparently the changes are not drastic in most cases, but Grunfeld told me that he's documented them. He said that certain antiretrovirals can then make the problem much worse.

As for it not being related to HIV, I'll just say this. I didn't ever have fat loss until after I was infected. To the contrary, I always had a pretty high body fat percentage despite a very careful diet and a vigorous workout routine. In addition, no one in my family has ever suffered a similar condition. Since my infection, though, I've had all of the classic symptoms of HIV-induced lipodystrophy. I don't have cancer, or diabetes, or any of the other known conditions that might explain this kind of fat loss. So I think it's reasonable to assume that HIV is the culprit. It may, of course, be acting in concert with some other genetic predisposition that I have -- something that wouldn't have caused trouble until HIV triggered it, for example. But all of this is speculation since no one really knows what causes lipo and no one is investigating folks like me.

Early on, I actually tried to get researchers interested in my case. That's how I ended up in Carl Grunfeld's office. I thought that it might offer the opportunity to observe the progress of lipodystrophy in a "pure" subject, i.e., someone whose problem could not be attributed to drugs. But I got nowhere on that front. I still think that people like me might possibly hold some answers, precisely because researchers could eliminate drugs as a factor. I would think that might make it easier to figure out the metabolic role of HIV in all of this.

But don't worry, I'm not holding my breath for the researchers. I've done what lots of folks here have done and gone to Tijuana for filler treatments.

I think you misunderstood me. All I said was that I personally am aware of only two such cases. I have heard anecdotally of others from doctors with whom I have consulted. So it looks like there are more of us out there, but obviously, we are a distinct minority. I should mention that when I consulted with Carl Grunfeld, who is a leading researcher in this field, he told me that his research has shown that HIV causes fat loss in virtually anyone infected, whether or not they are on antiretroviral drugs. Apparently the changes are not drastic in most cases, but Grunfeld told me that he's documented them. He said that certain antiretrovirals can then make the problem much worse.

As for it not being related to HIV, I'll just say this. I didn't ever have fat loss until after I was infected. To the contrary, I always had a pretty high body fat percentage despite a very careful diet and a vigorous workout routine. In addition, no one in my family has ever suffered a similar condition. Since my infection, though, I've had all of the classic symptoms of HIV-induced lipodystrophy. I don't have cancer, or diabetes, or any of the other known conditions that might explain this kind of fat loss. So I think it's reasonable to assume that HIV is the culprit. It may, of course, be acting in concert with some other genetic predisposition that I have -- something that wouldn't have caused trouble until HIV triggered it, for example. But all of this is speculation since no one really knows what causes lipo and no one is investigating folks like me.

Early on, I actually tried to get researchers interested in my case. That's how I ended up in Carl Grunfeld's office. I thought that it might offer the opportunity to observe the progress of lipodystrophy in a "pure" subject, i.e., someone whose problem could not be attributed to drugs. But I got nowhere on that front. I still think that people like me might possibly hold some answers, precisely because researchers could eliminate drugs as a factor. I would think that might make it easier to figure out the metabolic role of HIV in all of this.

But don't worry, I'm not holding my breath for the researchers. I've done what lots of folks here have done and gone to Tijuana for filler treatments.

John

I just wanted to jump in here a bit (this is for the orignal Poster and anyone else who's worried about lipo).............I have lipo (in the belly) and no where else, but I'm also 51 yr old and have been on Meds since 1991, I've also been HIV POS for the last 22 yrs. of my life, lipo is something that I have learned to live with like most of us long-tremers have, if your that worried about the way you look, it gets even WORSE when you get older,trust me I know THIS and if lipo is all you have to worry about, then I would suggest that you be happy that you are doing well on your meds, and that your still alive........I'm greatfull after 22 yrs of this, and I do hope that you comes to trems with your lipo, if that's all you have, then, you have nothing to worry about............be well ,and be happy that you are still ALIVE!

« Last Edit: April 18, 2008, 12:10:04 AM by denb45 »

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"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

I'm not trying to equate the difficulty and discomfort of lipo with the risk of dying. All of us are grateful that medications exist that will keep us alive. That said, lipo is more than a mere cosmetic condition. It makes it harder to walk, harder to sit for long periods, and harder to open bottles and jars. All of these things affect one's quality of life, some fairly severely. (Trust me, walking on wasted feet is no picnic.) On top of this, the condition leaves your skin thin and fragile, and therefore more susceptible to cuts and breakage, either of which can provide entry points for infectious agents. For example, last night I scratched my head lightly and ended up bleeding.

So I think all of us are grateful to be alive, and all of us are happy that meds can control the virus, even if the meds have unfortunate side-effects like lipo. But unlike you, I don't dismiss so lightly the seriousness of lipo as a condition. It's a feature of living with HIV that merits the attention of both medical practitioners and patients. I think saying that it's "all you have" understates the seriousness of the issue.

... lipo is more than a mere cosmetic condition. It makes it harder to walk, harder to sit for long periods, and harder to open bottles and jars. ... the condition leaves your skin thin and fragile, and therefore more susceptible to cuts and breakage, either of which can provide entry points for infectious agents.

John

I think the difference is the above could be categorized as inconveniences. The results of no meds is catastrophic and lethal.

I think that is the point denb is trying to get across.

After nearly 23 years with the bug and a dozen years on meds that would make newbies run in terror, I reserve the right to gripe about lipo, but I am not going to worry about it.

By the way, a lot of the above body changes, including the thinning of the skin, comes naturally as we age.

By the way, a lot of the above body changes, including the thinning of the skin, comes naturally as we age.

HUGS,

Mark

Yes, but some of us started to get lipo in our early 30's when none of this should have been happening from "aging" -- and as long as this is not medically solved that situation would continue if you are infected/diagnosed earlier in your life.

It all depends on what age you began taking meds really. But I agree, for those that don't have lipo hit them until their 50's it's hard to separate lipo out from aging in many instances.

I'm not trying to equate the difficulty and discomfort of lipo with the risk of dying. All of us are grateful that medications exist that will keep us alive. That said, lipo is more than a mere cosmetic condition. It makes it harder to walk, harder to sit for long periods, and harder to open bottles and jars. All of these things affect one's quality of life, some fairly severely. (Trust me, walking on wasted feet is no picnic.) On top of this, the condition leaves your skin thin and fragile, and therefore more susceptible to cuts and breakage, either of which can provide entry points for infectious agents. For example, last night I scratched my head lightly and ended up bleeding.

So I think all of us are grateful to be alive, and all of us are happy that meds can control the virus, even if the meds have unfortunate side-effects like lipo. But unlike you, I don't dismiss so lightly the seriousness of lipo as a condition. It's a feature of living with HIV that merits the attention of both medical practitioners and patients. I think saying that it's "all you have" understates the seriousness of the issue.

John

Yes............tell me about it, it's VERY painfull for me to walk around in my bare feet, I also have wasting in my face, but I don't worry about that too much, I'm not at all understating the seriousness of the Lipo & wasting issue.............it's a REAL Problem ( Bad Side-effect of the HIV Meds) and none of us can dissmiss that problem, but I too understand, (when I talk to my Doctor about this problem) they always say "well what do you want""why do you worry about the way you look" so, I don't FEEL a lotta of medical practitioners really see this as a problem, but I agree that this should at least be looked at as a problem and not dissmissed by so many doctors.............if i could just count how many doctors have told me that, I'm getting kinda sick of hearing that same one line said by so many doctors..........they all see this as a mere cosmetic condition, and nothing more, so, something somewhere DOES need to change for the better, but I don't see that happening any time soon.....................

« Last Edit: April 20, 2008, 01:20:23 PM by denb45 »

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"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

I've been on meds now since 2001.. Started on Sustiva and Triziver. Didn't start noticing fat loss in my buttocks/legs until 2006. Also started noticing slight hardness in belly, and protrusion. Moved to Atripla in 2006. The fat accumulation in the tummy and chest have progressively gotten worse, though, I work out a lot, and try to manage what I eat. Veins in legs are more pronounced. Been trying to figure out if I should come off the Atripla, or stay on it, and try to manage my triglycerides. Found an intersting article most of you might be interested in reading, if not already read, or aware..

I'm on Isentress, Truvada but instead of the Reyataz/Norvir your doctor suggested they're combined with Prezista/Norvir. I have lipo, but it pretty much stopped and stayed where it was about 2 years ago so I'm fairly confident in saying that this current combo has been good for me in that respect.

Also my lab numbers have been miraculous, and I've had little to none of the other typical side effects (nausea, headaches, diarrhea, etc.)

Hello everyone. I just joined and would like to share a few thoughts and questions. Thanks for reading and answering.

First, I think we need to stop selling ourselves short. I will NOT subscribe to the mentality that tells me I should feel grateful that I am not dead and learn to accept and deal with low quality of life, or a deformed body. I deserve to be healthy and I deserve to feel it and look it, too. If the industry (yes, healthcare is an industry) can come up with Botox and with billions of dollars' worth of means to making people look better and younger, it can figure out what is making my body change in strange ways and how to help me address it. We need to stop making ourselves accept the back seat of the bus when it comes to our health. Health, physical, mental and spiritual health includes, yes, looking good and comfortable in one's skin.

I have been poz for 12 years. I take care of my health. I stopped smoking, and drinking. I take my pills religiously. I see a cardiologist every 3 months. I do a cardio stress test, an echocardiogram, every year. I measure my sugar and triglicerides levels ever 3 months. I battle my lypo every which way I can. I exercise, try to eat well, keep my testosterone levels within normal range. I read and send articles to my doctors. I demand answers and options. I get facials, pedicures, and nice haircuts. And I expect my doctor to help me lead the effort to maintaining myself feeling AND looking good.

Now, question. Over the past 4 or 5 months I have seen a bothersome increase in the subcutaneous fat in my belly. In spite of my exercising 5 times a week and trying to eat a healthy diet. I was taking Sustiva and Epzicom and then switched to Atripla. My doctor and I stopped the Atripla , too, until we get some resistance results soon. I eliminated Lexapro a month ago since I didn't need it anymore and thought it could prove to be the culprit behind the fat gain. But nothing seems to be changing. I have gotten stricter about my diet (reducing portions and fat content, and increasing fiber). But this annoying gut is proving troublesome. It is not visceral. Some people say "it's just your being 41 finally catching up with you." If that's the case, I will continue exercising and dieting. If it's HIV, though, I want to try other options. My doctor suggested we could try Oxandrin (an anabolic) to see if that helps.

Hello everyone. I just joined and would like to share a few thoughts and questions. Thanks for reading and answering.

First, I think we need to stop selling ourselves short. I will NOT subscribe to the mentality that tells me I should feel grateful that I am not dead and learn to accept and deal with low quality of life, or a deformed body. I deserve to be healthy and I deserve to feel it and look it, too. If the industry (yes, healthcare is an industry) can come up with Botox and with billions of dollars' worth of means to making people look better and younger, it can figure out what is making my body change in strange ways and how to help me address it. We need to stop making ourselves accept the back seat of the bus when it comes to our health. Health, physical, mental and spiritual health includes, yes, looking good and comfortable in one's skin.

I have been poz for 12 years. I take care of my health. I stopped smoking, and drinking. I take my pills religiously. I see a cardiologist every 3 months. I do a cardio stress test, an echocardiogram, every year. I measure my sugar and triglicerides levels ever 3 months. I battle my lypo every which way I can. I exercise, try to eat well, keep my testosterone levels within normal range. I read and send articles to my doctors. I demand answers and options. I get facials, pedicures, and nice haircuts. And I expect my doctor to help me lead the effort to maintaining myself feeling AND looking good.

Now, question. Over the past 4 or 5 months I have seen a bothersome increase in the subcutaneous fat in my belly. In spite of my exercising 5 times a week and trying to eat a healthy diet. I was taking Sustiva and Epzicom and then switched to Atripla. My doctor and I stopped the Atripla , too, until we get some resistance results soon. I eliminated Lexapro a month ago since I didn't need it anymore and thought it could prove to be the culprit behind the fat gain. But nothing seems to be changing. I have gotten stricter about my diet (reducing portions and fat content, and increasing fiber). But this annoying gut is proving troublesome. It is not visceral. Some people say "it's just your being 41 finally catching up with you." If that's the case, I will continue exercising and dieting. If it's HIV, though, I want to try other options. My doctor suggested we could try Oxandrin (an anabolic) to see if that helps.

Thoughts/advice very much appreciated. Thanks all!

Well Welcome, nice to have you here with us

Your lucky you have a Doctor that's (on-your-side) and gives a shit......I know that sounds like a cop-out, but, for me it isn't, after 22 yrs. and as many doctors as I have had, all I get is the VERY BASIC HIV care, I don't know why it's that way for me, but, it could be that I'M LOW INCOME, and most of the doctors that I 'm FORCED TO USE...just don't CARE!, I mean ,for me it's always been that way, Money talks, and BULL SHIT walks, if you are lucky to have good HIV care ( and a lotta of us DON'T) we only get what we get, and that means, NO cosmectic MEDS,(my INS will only cover what's is needed and NOTHING more, No Surgery, unless you have the money to get it done, let alone, you only Bearly make eoungh to just LIVE on and makes ends meet, it's TOUGH, for a lotta low imcome HIV'ers out there like myself......YES I do agree, something does NEED to be done, but when your backed up against a wall of RED TAPE, and stuck in a system, that doesn't GIVE A SHIT about you..............there just isn't a whole lotta options to do anything.............some of us are FORCED to take a back seat, I know the System isn't perfect, it has a long long way to go, but, I do try to make the best out of what I do get out of it , cause, what else can I do, it is what it is...........

« Last Edit: May 07, 2008, 10:22:22 PM by denb45 »

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"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

You know what? You are ABSOLUTELY right. I'm sorry I so blindly neglected the reality you face while making my point. I am SO sorry to hear that you get bad basic care. Your story makes me angry.

I am lucky indeed to have a job that provides decent health insurance, although if I didn't have it, I'd be in the same boat as you. However, let me just say: even with "good" doctors I have to take ownership of my care. I drive them nuts. I ask questions. I demand answers. I research and send them links to articles. I refuse to accept explanations or treatments that don't make sense to me. I have been known to get 3, 4, or even 5 different opinions. I'm not sure if that's possible when you've got mediocre doctors. But perhaps the point I'm trying to make is: let's not give in to the sentences the world hands us. It's our lives, our bodies, and our rights to be considered as deserving as anyone with money, or with any other health condition.

You know what? You are ABSOLUTELY right. I'm sorry I so blindly neglected the reality you face while making my point. I am SO sorry to hear that you get bad basic care. Your story makes me angry.

I am lucky indeed to have a job that provides decent health insurance, although if I didn't have it, I'd be in the same boat as you. However, let me just say: even with "good" doctors I have to take ownership of my care. I drive them nuts. I ask questions. I demand answers. I research and send them links to articles. I refuse to accept explanations or treatments that don't make sense to me. I have been known to get 3, 4, or even 5 different opinions. I'm not sure if that's possible when you've got mediocre doctors. But perhaps the point I'm trying to make is: let's not give in to the sentences the world hands us. It's our lives, our bodies, and our rights to be considered as deserving as anyone with money, or with any other health condition.

Peace! And thanks for sharing your very, very real point.

Oh your welcomed .........I'm like that to,(questions, answers,) most of the doctors I've dealt with just LOOK at me ( like I'm carzy) but it doesn't get me very far, but, I'm kinda lucky too, dispite all the CRAPPY DOCTORS I've had thur the yrs. I'm still very healthy & Fit ( hell I even had some says)... 10 and 15 yrs ago........"what do you care" your going to Die anyway"......or some EVEN said..."Who cares what you look like, you have AIDS, so what are you suppose to look like, what the hell do you want to look like, a Male Model? a Movie Star, cuz that aint NEVER gonna happen as long as you have AIDS".......... if that's ANY induction of just what kinda doctors I have to deal with...........need I say more?....beauty is ONLY skin deep, but UGLY is to the BONE!, I know that doesn't sound very up-beat or positive to you, but, I'm going on 52 this yr, so, hunnie when you get THAT OLD, know one wants to look at you anyway ,but, somehow, I preservered, I PROVED them all wrong....I'm still here, and ALIVE

« Last Edit: May 08, 2008, 12:09:32 AM by denb45 »

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"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

I found out in 1986 that i was hiv poz..I didnt take any meds due to the fact that my friends that were on azt..were dropping like flies.

So I waited 16 yrs before I started treatment...6 yrs i am on meds, but my lypo started at the age of 51...

I noticed my legs got thinner and arms as well..then as time went on i developed vericous vains around my ankles...then in my upper thighs..

Then last summer when I was on the beach, I felt something funny on my face...When i went home it looked like i had red freckles all over my face ...Definatley sun damage....My skin has gotten so thin, so I have to watch out for the suntanning days, that will be over this summer...No more sun for me...

My doctor and I are the same age..53...There trying to say, oh well its a part of aging, but i told her to take off her shoe and she did, she didnt have any veins at all.Then I said let me look at your hands and skin....Hers looked much younger than mine.

they know hiv meds process aging much quicker than the average bear, but they dont want you to know or there just finding out how much we do age faster....

when you look good you usually feel good.and you dont mind looking in the mirror.

My hair was thinning so I saw this online that if you use extra virgin olive oil, and rub it into your hair line, the hairs will grow back. So I did this and believe it or not, i am now growing baby hairs back around my front scalp....

I was a hairdresser since 1974, so hair means alot to a women, sex appeal...Men is a bit different, they can shave there heads and it a style for them, but a women cant go that way..no not at all....

Anyway..I try my best to look good, but it also better to feel good as well..Now thats a new cocktail Id like to test out..

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Live Love Laugh and dance like no ones watching.Laughter is the best medicine, so try to have a laugh everyday..Even if your not feeling your best, think about something that was funny at one time in your life and work with it.. )

I found out in 1986 that i was hiv poz..I didnt take any meds due to the fact that my friends that were on azt..were dropping like flies.

So I waited 16 yrs before I started treatment...6 yrs i am on meds, but my lypo started at the age of 51...

I noticed my legs got thinner and arms as well..then as time went on i developed vericous vains around my ankles...then in my upper thighs..

Then last summer when I was on the beach, I felt something funny on my face...When i went home it looked like i had red freckles all over my face ...Definatley sun damage....My skin has gotten so thin, so I have to watch out for the suntanning days, that will be over this summer...No more sun for me...

My doctor and I are the same age..53...There trying to say, oh well its a part of aging, but i told her to take off her shoe and she did, she didnt have any veins at all.Then I said let me look at your hands and skin....Hers looked much younger than mine.

they know hiv meds process aging much quicker than the average bear, but they dont want you to know or there just finding out how much we do age faster....

when you look good you usually feel good.and you dont mind looking in the mirror.

My hair was thinning so I saw this online that if you use extra virgin olive oil, and rub it into your hair line, the hairs will grow back. So I did this and believe it or not, i am now growing baby hairs back around my front scalp....

I was a hairdresser since 1974, so hair means alot to a women, sex appeal...Men is a bit different, they can shave there heads and it a style for them, but a women cant go that way..no not at all....

Anyway..I try my best to look good, but it also better to feel good as well..Now thats a new cocktail Id like to test out..

I lost all my hair about 13 yrs. ago when I was on AZT, for some reason it NEVER grew back must be some side affect of the AZT......dunno but it was something that I learned to live with...........AZT killed a lotta of my freinds, but at the time, it was all they had.......sometimes we live what we've learned........I remember the 90's.......it wasn't fun

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"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

I lost all my hair about 13 yrs. ago when I was on AZT, for some reason it NEVER grew back must be some side affect of the AZT......dunno but it was something that I learned to live with...........AZT killed a lotta of my freinds, but at the time, it was all they had.......sometimes we live what we've learned........I remember the 90's.......it wasn't fun

denb45 -- were you on a combo 13 years ago? There have been rare reports of alopecia (hair loss) with Crixivan.

You are right -- the early 90's were horrible, as were the 80's. Thank god we survived them.

I was on AZT off & on from 1990 to 1994, then VIDEX, then Crixivan, I could go on & On , but the list is WAY TO LONG , if you can name it I've been on it before..........right now the only thing I have is whatever SALAVGE MEDS that work, and as you know they are a lotta stuff I've already taken............I lost 99% of all body hair while on AZT ,to date no one knows why? I can grow hair on my face ( I shave) but it hasn't grown anywhere else since the 90's AZT Treatments.....but I'm going on 52, so, AGE my be a factor too ( some of us go GRAY), I don't, I go, BALD

« Last Edit: May 09, 2008, 12:21:28 PM by denb45 »

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"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

Hi , I suffer from terrible lipo , for years,...so I decided untill there will be any cure I should try fix it for as much as possible for improving my self image and I found clinica estetica here at this forum in Tijuana, I am very hapy with the results... I will send you pictures if you wants, I did a long way fromIsrael to TJ and I am so glad I made this decission,,, I know its not the ultimative solution biut at least now I feel better with the way I look and gettngmany comlpiments...

denb45 -- were you on a combo 13 years ago? There have been rare reports of alopecia (hair loss) with Crixivan.

I know of at least three persons including myself who has experienced hair loss with Crix.

10 yrs ago I started on Crix + Norvir + Combivir, and it was a really bad meds combo for me. It made so nauseous so I threw up most of what I ate, my nails went all soft, I started loosing hair, I got kidney stones and anaemia. I would never touch Crix again even if it was the only working medication left.